Active NPI
Julie Moore
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1043564750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 30549
- Practice address
- 1625 Schrader Blvd
Los Angeles, CA 90028-6213 - Phone
- (323) 860-5889
- NPI assigned
- Nov 1, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | 30549 | CA | Primary |
Addresses
Primary practice location
1625 Schrader Blvd
Los Angeles, CA 90028-6213
Mailing address
161 W Altadena Dr # 1056
Altadena, CA 91001-4735
Phone (626) 429-4476
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01261511 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 16, 2024 through May 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680048000000",
"number": "1043564750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "161 W ALTADENA DR # 1056",
"city": "ALTADENA",
"state": "CA",
"postal_code": "910014735",
"telephone_number": "626-429-4476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 SCHRADER BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900286213",
"telephone_number": "323-860-5889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "JULIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-11-01",
"last_updated": "2023-03-29",
"certification_date": "2023-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "30549",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01261511",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.